Where to get drugs

I’m not talking here about visits to Brixton, but about how people are acquiring medications without proper safeguards and with potentially dangerous consequences.  Here are some of the methods employed

1. Go to your local doctor and simply ask nicely.
Last month the papers told us about a parliamentary inquiry which concludes that doctors are prescribing drugs such as analgesics, benzodiazepines and night sedation for much longer than they should and will sometimes renew repeat prescriptions without even seeing patients.

2. ‘Over the counter’
There is also concern about the availability of medicines in this way; some of them are actually quite potent and there are reports of people becoming ‘hooked’ on analgesics bought in this way.  Apparently Neurofen Plus and Solpadeine are the worst in this regard, both contain codeine which is an opiate. 

3. Buy them abroad, customs permitting. 
Recently I went to Syria and was interested to note that drugs available on a prescription-only basis in the UK could be purchased from the pharmacist without a doctor’s involvement.  Drugs available in this way included Clozapine, which can cause fatal side effects. 

4. The Internet
A simple websearch reveals a number of websites happy to supply a wide variety of medications without prescription and available to ‘ship worldwide’.  This includes methylphenidate which is a restricted drug in the UK.

Please note that I do not advocate medicines acquisition by any other method than via a sensible discourse with your doctor. 


Cannabis and Jacqui Smith

The day after Gordon Brown announced that Home Secretary Jacqui Smith was to head up a review of UK drugs strategy she announced that she herself was not entirely unfamiliar with recreational cannabis use, having smoked it during her studies in Oxford.

Although she has kept this to herself for the past 25 years, she has clearly ruminated on her behaviour producing this complex analysis:

‘I did break the law… I was wrong… drugs are wrong’

Ms Smith managed to come over like all politicians do when they’re telling us not to do things they’ve done themselves – wheedling and unconvincing. The Guardian’s Zoe Williams nicely punctured this hypocrisy in a recent article. Following Smith’s lead several other members of the cabinet, including the Chancellor, also admitted to have previously indulged. In 2000 eight members of the then shadow cabinet admitted similar misdemeanors.

Also in the news, The Lancet (1) publishes a study which concludes that the risk of developing psychosis is increased by 40% in smokers of cannabis, and that this is a dose-response effect leading to an increased risk of 50-200% in very heavy users.
So, we have a drug used all over the world, associated on the one hand with serious mental health disorders, on the other with counter-culturalism, creativity and plain ol’ having fun. People with multiple sclerosis testify that it eases the symptoms of their disease. It’s regularly used by thousands of people in the UK. But it’s illegal and its distribution the business of criminals.

Before I started working in mental health I used to think that legalising cannabis use was quite a good idea – I’m now officially sitting on the fence. It’s true that many people use it without perceiving any ill effects. It’s true that intoxication following smoking does not engender any of the anti-social behaviour that is a scourge on our alcohol soaked high streets at night. However our psychiatric in-patient wards are full of people who might not be there had they had no access to the drug, and many of our recurrent admissions are because our patients refuse to relinquish the habit. How would things be if cannabis were to be as readily available as cigarettes?
Having been downgraded to a class C drug in 2004 there is now talk of cannabis returning to class B, the dubious existence of stronger strains being evidence for this U-turn. I do wonder how much of this is political posturing, a government aiming to not be ‘soft on drugs’. In some places a tightening of attitudes is evident – I endured a two sniffer dog searches at this year’s Glastonbury Festival.

Whether the law on cannabis is tighten up or not people need to be able to make up their own minds and weigh up the consequences of their actions. If at the same time we could avoid criminalising large parts of the population, that would be good. Simple pronouncement of the kind favoured by the Home Secretary aren’t very helpful.

1. Theresa H Moore et al Lancet 2007; 370: 319–28

The Devil’s Cup

There is a coffee shop in East London’s Brick Lane which proudly displays the sign ‘Come happy, leave edgy’ on the pavement outside its front door. Look at it one way and our society is permeated with establishments vending pleasing pick-me-up drinks to lighten the fatigue of socialising punters. Look at it another and we’re beset by drug pushers dealing a psychostimulant so skilfully disguised that we hardly notice. And in common with other drugs it’s big business: only oil exceeds coffee as a globally traded commodity.

Each cup of coffee contains approximately 100mg of caffeine, each cup of tea 50mg. Caffeine’s mechanism of action is not fully understood but appears to be dose related; it has a stimulating effect on the central nervous system, heart, blood vessels, and kidneys and also acts as a mild diuretic. The positive effects of moderate doses (up to approximately 200-300mg daily) include improved motor performance, decreased fatigue, enhanced sensory activity, and increased alertness.

However it is also recognised that habitual users of caffeine can suffer from symptoms of withdrawal and a dependence syndrome is also described. DSM-IV lists four caffeine-induced psychiatric disorders: caffeine intoxication, caffeine-induced anxiety disorder, caffeine-induced sleep disorder, and caffeine-related disorder not otherwise specified. A 2004 analysis (1) lists the following as attributable effects to caffeine withdrawal, and found that as little as one cup a day of coffee can produce a caffeine addiction:

headache, fatigue, decreased energy/activeness, decreased alertness, drowsiness, decreased contentedness, depressed mood, difficulty concentrating, irritability, and foggy/not clearheaded, flu-like symptoms, nausea/vomiting, and muscle pain/stiffness.

If this doesn’t bother you, another study in 1994 (2) found caffeine withdrawal to carry with it such behaviours as screaming at the children, missing work, going home early, and cancelling a child’s birthday party.

The majority of our intake comes from tea and coffee, but it is also available in energy drinks, food and tablet form. You can see from this list that there is a wide range of caffeine doses. The caffeine content of coffee is well known, but what about that in chocolate or 7-UP? Starbucks coffee comes out top of the ‘caffeine content’ pops, the speculation is that it is not the strong flavour and distinctive aroma (piped into the street) that keeps customers coming back for more, it is – like other addictive drugs – the avoidance of withdrawal effects.

Furthermore, unlike oil or tobacco, caffeine is neither regulated nor taxed. I’ll give Roland Griffiths, professor of psychiatry and neuroscience at Johns Hopkins the last word:

“We need to recognize that caffeine really is a drug and accord it respect as a drug. People need to know what it does when they take it, and what it does when they cease to take it, and make an adult decision about that”.

(1) Juliano, L. M., Griffiths, R. R. (2004) A critical review of caffeine withdrawal: empirical validation of symptoms and signs, incidence, severity, and associated features Psychopharmacology 176, Number 1 / October 2004 1-29

(2) Strain, E., Mumford G. K., Silverman, K., Griffiths R.R. (1994) Caffeine dependence syndrome: evidence from case histories and experimental evaluations JAMA 27 1043-8

In the press

I’ve  spent how much on coffee?  Polly Vernon Observer 23 June 2008

Caffeine related psychiatric disorders – eMedicine